Department of Otorhinolaryngologyhttps://med.uth.edu/orl
Department of Otorhinolaryngology - Head and Neck Surgery | University of Texas Medical School at HoustonWed, 25 Mar 2015 06:05:59 +0000en-UShourly1http://wordpress.org/?v=3.8.5The Story Behind the MicroSeismic Donationhttps://med.uth.edu/orl/uncategorized/the-story-behind-the-micoseismics-donation/
https://med.uth.edu/orl/uncategorized/the-story-behind-the-micoseismics-donation/#commentsSat, 27 Dec 2014 14:21:04 +0000https://med.uth.edu/orl/?p=6222Read the full article...]]>MicroSeismic has made a $50,000 donation to the Memorial Hermann Foundation to help Children’s Memorial Hermann Hospital and the Department of Otorhinolaryngology at UTHealth Medical School provide hearing aids to underserved pediatric patients in the Greater Houston area.

]]>https://med.uth.edu/orl/news/2014-highlights/feed/0A Gift of Hearinghttps://med.uth.edu/orl/newsletter/a-gift-of-hearing/
https://med.uth.edu/orl/newsletter/a-gift-of-hearing/#commentsTue, 02 Dec 2014 00:42:14 +0000https://med.uth.edu/orl/?p=6183Read the full article...]]>In 2014, Houston-based MicroSeismic, Inc., made a $50,000 donation to the Memorial Hermann Foundation to help Children’s Memorial Hermann Hospital and the Department of Otorhinolaryngology at UTHealth Medical School provide hearing aids to underserved pediatric patients in the Greater Houston area. Just weeks later, eight-year-old Victor Herrera was the first beneficiary of the company’s generous gift.

Victor has worn hearing aids since he was four, when his mother Priscilla Herrera scheduled a hearing test after she noticed that he did not appear to be listening. He was diagnosed with moderate-to-severe sensorineural hearing loss in his right ear and profound loss in his left ear, and he then received hearing aids.

In 2013, Herrera’s purse and Victor’s hearing aids were stolen from her car. “Hearing aids are expensive, and we were trying to figure out how to get them replaced as quickly as possible. He’d been without them for about four months and was getting behind in school when I was surprised by a phone call from UTHealth Audiology saying he qualified for help from the MicroSeismic grant.”

“The medical cost of hearing aids starts at around $1,000,” says Soham Roy, MD, FACS, FAAP, director of pediatric otorhinolaryngology at Children’s Memorial Hermann Hospital and an associate professor at UTHealth Medical School. “Some underfunded children in Texas cannot qualify for hearing aids under Texas Medicaid programs, which leaves many families unable to afford the expense required to correct their child’s hearing. Hearing loss affects speech and language skills, which can lead to learning problems, social isolation and poor self-esteem, all of which have a detrimental effect on a child’s development. Thanks to the generosity of MicroSeismic, children like Victor who might have fallen through the cracks can overcome obstacles resulting from hearing impairment.”

Priscilla Herrera is grateful for the help Victor received. “I’m so thankful to everyone who has helped us through this hard time,” she says. “It’s a wonderful experience to know that people care.”

Since Victor received his replacement hearing aids, 13 other children have been tested and fit using funds from the MicroSeismic grant, including four-year-old Raniyah Stevenson and five-year-old Isabella Garcia, both of whom are first-time hearing-aid users.

“Raniyah passed her newborn hearing screening and initially had normal speech-language development,” says Mackenzie Hill, Au.D., one of three audiologists at UTHealth Audiology. “It wasn’t until her speech became less and less intelligible, especially to familiar listeners – and she needed constant repetition from her mother – that concerns for her hearing arose.” Raniyah’s mother Janeika Moore also noticed that her daughter kept turning up the volume on the TV and always spoke in a louder-than-normal voice. When Moore scheduled a speech and hearing evaluation, her daughter failed the hearing screening, and then Raniyah underwent a comprehensive audiological evaluation which confirmed a diagnosis of mild-to-severe sensorineural hearing loss in the right ear and severe-to-profound hearing loss in the left ear.

“Within a three-month period, this little girl went from having her hearing loss identified by UTHealth Audiology and was fit with hearing aids through the MicroSeismic grant,” Dr. Hill says. “Raniyah received bilateral behind-the-ear hearing aids and chose a fashionable transparent purple color for the devices. She designed her ear molds with purple glitter, so that her ears are as sassy as she is.” Follow-up testing revealed a 30-decibel improvement with the hearing aids compared to her unaided thresholds to sound and speech.

Today, Raniyah recognizes the sounds she was missing, her mother says. “She’s been doing speech therapy through school since November 2013 and is catching up to where she needs to be,” Moore says.

Isabella Garcia, another beneficiary of the MicroSeismic grant, was diagnosed with bilateral mild sensorineural hearing loss. “We wanted to move quickly because we knew that hearing loss, even if it’s mild, can have negative effects on school performance and social and emotional development,” says her mother Crystal Hunter. “As long as she’s wearing her hearing aids she’s good, but without them sounds are muffled.”

Isabella wears binaural “open-fit” behind-the-ear hearing aids. “She chose pink devices and decorated them with stickers,” Dr. Hill says. “During her initial follow-up appointments we determined that amplification was providing ample benefit. Her most recent test revealed a 30- to 40-decibel improvement in hearing compared to her unaided thresholds to sound and speech. With hearing aids she can now hear at normal levels.”

Hearing loss is one of the most common abnormalities at birth with an incidence of one in 10,000 to one in 12,000 live births in the United States. “It’s also believed that the percentage of children with permanent hearing loss is much higher – three in 1,000,” Dr. Roy says. “The numbers are variable based on the source. The bottom line is that early detection is crucial. Kids who are identified early have better outcomes in terms of speech, meeting appropriate developmental levels and academic progress.

“Unfortunately, in Texas many Medicaid plans don’t provide hearing aid coverage, which means that a lot of families don’t have access to testing and appropriate therapies,” he adds. “With this grant we can provide hearing aids for kids who otherwise might not get them. The MicroSeismic people believe in advancing technology and in giving back. They believe in helping children who otherwise wouldn’t be helped. Thanks to their generosity we’ll be able to help 20 to 25 children this year. It’s been the highlight of my year to be able to provide what these kids need to improve their lives.”

]]>https://med.uth.edu/orl/newsletter/a-gift-of-hearing/feed/0Breath of Fresh Airhttps://med.uth.edu/orl/newsletter/breath-of-fresh-air/
https://med.uth.edu/orl/newsletter/breath-of-fresh-air/#commentsTue, 02 Dec 2014 00:32:59 +0000https://med.uth.edu/orl/?p=6181Read the full article...]]>Many of us have a touch of “sinus” from time to time. But for Sandra Butcher, a sinus problem turned into a miserable bout of chronic rhinosinusitis. After two-and-a-half years of discomfort, medication and doctor visits, Butcher’s story ended happily with the help of otorhinolaryngologist Martin J. Citardi, MD, FACS, chief of otorhinolaryngology—head and neck surgery at Memorial Hermann-Texas Medical Center and professor and chair of the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School.

Martin J. Citardi, MD

Butcher, her husband Larry and their three daughters moved from California to Corpus Christi in 1979, when Larry took a job in the oilfields. Aside from the occasional head cold, Butcher, 68, who works at a Ford dealership, had always enjoyed good health – and playing sports.

“I like to do it all – baseball, basketball, kickball, snowmobiling, golf, aerobics,” Butcher says. The couple also enjoys dirt-track racing. And Butcher is a power lifter: Eight years ago, she set a record for bench-pressing 137 pounds. She kept going strong well into her 60s – until 2009, when she went to her doctor with what felt like a cold.
“I kept having that tickle in the back of my throat, and I’d cough and cough,” Butcher recalls. “I was very, very congested.”

As her symptoms progressed, two rounds of antibiotics to knock out a potential bacterial infection didn’t help. Neither did decongestants. Butcher began to have trouble hearing. She even suffered asthma flare-ups that frightened her husband and sent her to the emergency room.

Butcher began visiting an allergist for daily shots. She and her husband bought new bedding to cut down on allergens, and they banished their beloved dogs, Zippy and Kinser, from the house.

“Did I snore? Just ask my husband!” Sandra says.

“We’ve got two bull mastiffs, and she outdid ‘em!” he adds.

Increasingly desperate, Butcher visited a nearby ear, nose and throat specialist, who performed sinus surgery. But the surgery did not improve her symptoms. Another specialist offered contradictory advice about medications. In the meantime, she had nasal congestion and obstruction, causing her to breathe through her mouth, and she felt tired all the time. She gave up active lifestyle.

“I was miserable,” Butcher recalls. “At night, I slept propped up. On weekends, I would sit in my chair and sleep — I couldn’t do anything. I just barely made it to work every day.”

Chronic rhinosinusitis (CRS) is an uncomfortable condition in which the lining of the nasal passages and the adjacent paranasal sinuses become inflamed and swollen for 12 weeks or more without responding to treatment. Normally, the sinuses and nasal passages produce a small amount of mucus that keeps them moist and catches dust, bacteria and other inhaled debris. The mucus drains to the back of the nose, where it is swallowed. If inflammation swells the sinuses, that drainage may be blocked, and the mucus collects and becomes infected.

If untreated, the condition leads to nasal congestion, making it difficult to breathe through the nose. Smell and taste can grow dull. Depending on which sinuses are involved, the face can become tender to the touch over the cheekbones or forehead. Some people suffer discomfort in the ears, bad breath, cough, fatigue, and even nausea. Constantly uncomfortable, people with CRS may find themselves unable to engage in their ordinary activities.

Although not usually life threatening, the condition can erode quality of life as badly as serious chronic diseases like diabetes and congestive heart failure. “It’s like having a bad head cold, every day, without end,” notes Dr. Citardi. “Also, these patients are constantly going back and forth to physicians, and being in that sick role magnifies the sense of not being well.”

Butcher can relate. “I thought, ‘Oh my God, am I going to have to live the rest of my life like this?’” she recalls. “I was really depressed.”
Because her condition did not improve, Sandra’s ENT surgeon finally referred her to Dr. Citardi. In addition to being board certified in otorhinolaryngology, he is trained in the subspecialty of rhinology and is one of three rhinology subspecialists who are core members of UTHealth’s Texas Sinus Institute (www.texassinus.org).

“Most of our patients have had one or more previous surgeries,” Dr. Citardi says, “so we are often the last stop for someone like Sandra.” He examined Butcher’s sinuses with a nasal telescopeand saw scarred pockets, inflamed sinus linings, polyps and abnormal secretions too thick to drain.

Based on his examination, his conversation with the Butchers, and a review of her medical record, Dr. Citardi concluded that she would benefit from a procedure called image-guided functional endoscopic sinus surgery (IG-FESS). This minimally invasive operation allows the surgeon to clean the sinuses, remove debris and open up blocked passages so that secretions can drain again. Because the work is done through the nostril, there is need for facial incisions. Often, the patient goes home on the same day.

“After we do the procedure,” Dr. Citardi says, “all the other medical treatments work better.”

As soon as she awoke from anesthesia, Butcher could tell the difference. “I felt so much better. It was like night and day,” she recalls. “I didn’t have that pressure on my chest anymore. I could breathe.”

Surgery for CRS isn’t a complete cure. But because operations like IG-FESS can fix the “plumbing” problem in the sinuses and nasal passages, it can make treatment for infection or inflammation far more effective. With follow-up medical treatments, including steroids and topical antibiotics, and careful attention to flare-ups, Butcher has done well.

“After the surgery and my next couple of visits, every time I saw Dr. Citardi, I’d just give him a big old hug because he changed my life. He really did,” Butcher says. She pauses. “I get emotional,” she adds.
Doctors don’t fully understand the causes of CRS. Years ago, they emphasized antibiotics because infection was thought to be the underlying problem. Today, they believe that CRS results from out-of-control inflammation in the sinus lining. Patients with CRS often have asthma, a disorder with similar inflammation in the lining of the lungs. Some patients with CRS are also allergic to inhaled materials, although most researchers think of these two conditions as separate processes that may occur together.

Some CRS patients also have nasal polyps. Allergic fungal rhinosinusitis (AFRS) is a special type of CRS with nasal polyps that includes an inflammatory reaction to common fungi.
Treatment starts with making sure the diagnosis is correct – and with not mistaking less serious conditions for CRS. “Most episodes of nasal symptoms are self-limiting and probably do not need much treatment,” Dr. Citardi notes.

For example, acute viral infections of the nasal lining (acute rhinitis, or a “cold”) are common, but they improve with simple supportive measures. About 2 to 5 percent of patients with acute rhinitis develop an acute bacterial sinus infection, which is best treated with oral antibiotics. Inhalant allergies, also known as allergic rhinitis (allergic inflammation of the nasal lining), respond well to treatment with oral and spray antihistamines and nasal steroid sprays.

CRS is different, with symptoms that include three or more months of nasal congestion, facial pressure and/or foul nasal discharge. The sense of smell may also be affected. Treatments include steroid sprays and pills as well as antibiotics. Flushing the sinuses with a saline solution can help.

If these medical treatments don’t work, then a patient with persistent CRS may be a candidate for sinus surgery. Functional endoscopic sinus surgery (FESS) was introduced 30 years ago, and since then numerous technological innovations have improved it. Many of these surgeries use computer-based image guidance, a technology that works as a GPS system to help guide the surgeon during the operation. Balloon sinuplasty is another tool that may be used during sinus surgery.

Some patients try complementary and alternative medicine treatments for CRS. Dr. Citardi advises caution, since many of those treatments are unstudied and potentially impure. And substituting unstudied treatments for more tried-and-true approaches can rob the patient of opportunities to get better.

“I have seen patients who spend thousands of dollars each month on alternative medicines, and then they come back worse than ever before,” Dr. Citardi says. He suggests that patients trying alternative treatments at least keep their doctors in the loop.

These days, Butcher feels great. She manages her sinuses with a bedtime nasal spray. She’s sleeping flat and has stopped snoring. Zippy and Kinser are allowed back in the house. And she’s active again: she’s doing aerobics and 5K races, and on weekends she helps her husband with his lawn service.

“She’ll outdo me, mowing and everything,” Larry Butcher says. “Oh, and kickball. This coming year, Sandra, her daughters and granddaughters are all on the same kickball team. They call themselves The Chicks. And they’re undefeated.”

Life, in other words, is back to normal. “If I can get out of the house,” Butcher says, “I will.”

“Breath of Fresh Air” originally appeared on May 14, 2014, in Health Leader, an online magazine produced by The University of Texas Health Science Center (UTHealth).

]]>https://med.uth.edu/orl/newsletter/breath-of-fresh-air/feed/0Current Pediatric Guidelines for Tonsillectomyhttps://med.uth.edu/orl/newsletter/current-pediatric-guidelines-for-tonsillectomy/
https://med.uth.edu/orl/newsletter/current-pediatric-guidelines-for-tonsillectomy/#commentsMon, 01 Dec 2014 22:01:12 +0000https://med.uth.edu/orl/?p=6174Read the full article...]]>Tonsillectomy is the third most common procedure performed on children in the United States – after circumcision and myringotomy with pressure-equalizing tube placement (also known as “PE tubes”) – with more than half a million annual procedures in pediatric patients younger than age 15. A guideline released by the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) in 2011 has resulted in safer surgery and improved the quality of life for children with large or infected tonsils.

Soham Roy, MD, FACS, FAAP, director of pediatric otolaryngology and quality officer in the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School. “The current statement is the first – and only – national evidence-based guideline on tonsillectomy in the United States.”

Intended for all clinicians in any setting who interact with children aged 1 to 18 years who may be candidates for tonsillectomy, the AAO-HNS guideline was created by a multidisciplinary panel, including consumers and healthcare professionals representing otolaryngology—head and neck surgery, pediatrics, family medicine, anesthesiology, sleep medicine, infectious disease and nursing. It notes that most children with frequent throat infections get better on their own, making watchful waiting the best choice for children with fewer than seven episodes of tonsillitis in a year, five episodes a year for two years in a row, or three episodes a year for three consecutive years. The panel agreed that tonsillectomy can improve quality of life and reduce the frequency of severe throat infection in cases where these conditions are present.

According to the guideline, certain children with less frequent or severe throat infections may still benefit from tonsillectomy if there are moderating factors, including antibiotic allergy/intolerance, a history of peritonsillar abscess or PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and adenitis).

Because large tonsils can obstruct breathing at night and cause sleep-disordered breathing (SDB), physicians should ask parents of children with large tonsils and SDB about growth delay, poor school performance, bedwetting and behavioral problems.

On the use of medication, the guideline states that physicians should give a single intravenous dose of dexamethasone during tonsillectomy to reduce pain, nausea and vomiting after surgery. They should not routinely prescribe antibiotics to improve recovery following surgery – there are associated risks and side effects, and medical studies show no consistent benefits over placebo.

“As a result of the guideline, clinicians can better identify the best candidates for tonsillectomy – and those who are not,” says Dr. Roy, whose clinical interests are airway disorders in children, neonatal airway surgery, hearing loss, tonsil and adenoid disorders and neck masses in children. “It has also allowed physicians across the country to optimize care, improve quality, minimize harm and reduce inappropriate variations in care.”

]]>https://med.uth.edu/orl/newsletter/current-pediatric-guidelines-for-tonsillectomy/feed/0Profile in Caring: José Elías, RN, CORLNhttps://med.uth.edu/orl/newsletter/profile-in-caring-jose-elias-rn-corln/
https://med.uth.edu/orl/newsletter/profile-in-caring-jose-elias-rn-corln/#commentsMon, 01 Dec 2014 21:54:44 +0000https://med.uth.edu/orl/?p=6170Read the full article...]]>When José Elías was 10 years old, his mother, a Red Cross nurse, began making neighborhood house calls after hours to care for the sick in their hometown of Nuevo Laredo, Mexico. She went where she was needed late in the evening and asked José, the eldest boy and the second of seven children, to accompany her.

“I have vivid memories of watching her boil the syringe and put it in a container with alcohol and cotton balls,” Elías says. “I saw the satisfaction she gained from helping the community, and the gratitude of the people she helped. I thought I would like to be, if not a doctor, then a nurse.”

Elías and his family immigrated to the United States in 1981, during his sophomore year in high school, and settled in Northwest Houston. “The transition was difficult,” he recalls. “I was a teenager and didn’t speak English. We had to learn a new language and a new way of living. That’s a hard age to absorb and adjust to such a change.”

After graduation, he held various jobs, all of which he found unsatisfying. “I still had the desire to do something for the community,” he says. “I wanted to go home at the end of my work day and know that I had helped people, so I enrolled in the medical assistant program at Texas School of Business.”

In 1997, he accepted a position as office manager for the Center for Ear, Nose and Throat operated by University of Texas (UT) Physicians. At the age of 37, while working as a medical assistant at another UT Physicians clinic, he enrolled in the Associate Degree of Nursing (ADN) program at Lone Star College in Houston.
After completing his first year of nursing school, Elías, a United States Navy Reserve corpsman, volunteered to serve his country in Operation Iraqi Freedom. From May 2004 through April 2005, he was assigned to a Marine battalion aid station in Iraq, not far from the Syrian border, where injured soldiers were sent from the front for evaluation and triage back to action, to hospital care or to home. Following his tour of duty, he resumed his nursing studies, graduating with his ADN degree in 2006.

That same year, he was hired as a pediatric clinical nurse in the department of Otorhinolaryngology’s ENT Clinic, fulfilling a lifelong dream. “ENT has always attracted me because of the variety of patients we see – from children to adults – with problems that range from common to complex, from acute trauma to chronic issues,” he says. “In the 21 years I’ve been associated with UTHealth Medical School, I’ve seen dramatic advances in the technology we use and the quality of care we provide our patients.”

During that time, he has worked with five ENT department chairs, including Martin J. Citardi, MD, FACS, who is chief of otorhinolaryngology at Memorial Hermann-Texas Medical Center and professor and chair of the department of Otorhinolaryngology—Head and Neck Surgery at UTHeath Medical School. Dr. Citardi’s practice has grown exponentially since his arrival in 2006.

“Originally, we planned to recruit two new physicians a year, but within two years after Dr. Citardi’s arrival we had added eight doctors,” Elías says. “We moved from the UT Professional Building, where we had four exam rooms, to the Memorial Hermann Medical Plaza, where we have 17 rooms. As the practice grew, we hired more support staff.”

In 2007, Elías was promoted to nurse coordinator of the Texas Medical Center office. A year later, he moved up to the nurse manager position for the department of Otorhinolaryngology—Head and Neck Surgery.

“José has grown with our practice, developing new skills as he assumed more managerial responsibility,” Dr. Citardi says. “His help in setting up operations for a very complex outpatient clinic where we do many procedures has been invaluable. I can’t begin to say enough good things about José’s contribution to our practice – and the patients love him.”

Today, Elías supervises the work of nine medical assistants and manages two clinics with 12 affiliated physicians. He’s a devoted husband and the father of three children, two of whom live at home. He’s also enrolled in the RN to BSN program at The University of Texas at Arlington, which he expects to finish by the spring of 2016.
“It’s tough to balance it all – working fulltime, raising a family and finding time to write papers and study for weekly exams,” he says. “I do it because I believe there’s a purpose in life. I want to be remembered as someone who made a contribution to medicine and also to the community. I’m fortunate to work in a great practice with doctors who are working to transform medicine. As a nurse, I want to know that my patients are satisfied with their care. I also enjoy the teaching aspects of nursing and take extra time to make sure patients understand how they can stay healthy.”

Elías is an active member of the Houston Chapter of the Society of Otorhinolaryngology—Head and Neck Nurses. As a certified otolaryngology nurse (CORLN), he encourages other nurses in the ENT community to take the certification exam. “It’s our responsibility as nurses to keep growing – for our patients and ourselves.”

]]>https://med.uth.edu/orl/newsletter/profile-in-caring-jose-elias-rn-corln/feed/0Amber Luong, MD, PhD, Awarded CCTS Grant in Support of Continued Chronic Rhinosinusitis Investigationshttps://med.uth.edu/orl/newsletter/amber-luong-md-phd-awarded-ccts-grant-in-support-of-continued-chronic-rhinosinusitis-investigations/
https://med.uth.edu/orl/newsletter/amber-luong-md-phd-awarded-ccts-grant-in-support-of-continued-chronic-rhinosinusitis-investigations/#commentsMon, 01 Dec 2014 21:47:44 +0000https://med.uth.edu/orl/?p=6168Read the full article...]]>An immune-mediated inflammatory disease involving the paranasal sinuses, chronic rhinosinusitis (CRS) affects more than 10 percent of the population and is the second most common chronic disease in the United States. Despite its high incidence, the pathogenesis of CRS remains poorly understood, and no curative treatment exists.

Amber Luong, MD, PhD

“Recent studies by our lab revealed a close association of type 2 innate lymphoid cells (ILC2) and mast cells in CRS patients,” says Amber Luong, MD, Ph.D., FACS, who is co-principal investigator with Yeonseok Chung, Ph.D., of a new research project entitled Interplay Between Mast Cell and Type 2 Innate Lymphoid Cells in Chronic Rhinosinusitis, funded by a $50,000 Center for Clinical and Translational Science (CCTS) Pilot Project Award. “In addition, our unpublished study demonstrates that mast cells are required for the generation of ILC2 in an animal model of allergic asthma. This new grant is allowing us to investigate the role of mast cells in the generation and function of ILC2 as a main pathogenesis of CRS in humans, a relationship that remains unexplored.” The study will be supplemented by Dr. Chung’s work investigating the role of ILCs on mast cells using a mouse model.

Dr. Luong is an associate professor and director of research in the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School, and directs a laboratory at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases at UTHealth Medical School.

“Some relatively newly described data suggests that innate lymphoid cells may play a more extensive role in initiating and propagating the immunological response characteristic of chronic rhinosinusitis with nasal polyps (CRSwNP),” she says. “Innate lymphoid cells are clearly the first responders, as we showed in a publication in August 2013.[1] There is some evidence in the literature that they play a more central role in the initiation and propagation of T helper 2 (Th2) response by coordinating both the adaptive and innate immune response. In this new study we’ll determine the relationship between ILC2 and mast cells and Th2 lymphocytes isolated from CRS patients ex vivo and determine the mechanism of mast cell regulation of ILC2 and Th2 during airway inflammation in vivo with a mouse model of allergic airway disease.”

The goal of the Center for Clinical and Translational Sciences is to facilitate clinical and translational research at The University of Texas Health Science Center at Houston, The University of Texas M. D. Anderson Cancer Center and the Memorial Hermann Health System. The CCTS is one of the original 12 centers funded by the National Institutes of Health’s Clinical and Translational Science Awards, which are designed to strengthen and support the entire spectrum of translational research from scientific discovery to improved patient care.

]]>https://med.uth.edu/orl/newsletter/amber-luong-md-phd-awarded-ccts-grant-in-support-of-continued-chronic-rhinosinusitis-investigations/feed/0Three ORL Faculty Members Named to Top Doctor Listshttps://med.uth.edu/orl/newsletter/three-orl-faculty-members-named-to-top-doctor-lists/
https://med.uth.edu/orl/newsletter/three-orl-faculty-members-named-to-top-doctor-lists/#commentsMon, 01 Dec 2014 21:40:13 +0000https://med.uth.edu/orl/?p=6161Read the full article...]]>Martin J. Citardi, MD, FACS, Samer Fakhri, MD, FACS, FRCS(C), and Soham Roy, MD, FACS, FAAP, have been named among the Best Doctors in America® for 2014.

Martin J. Citardi, MD

An internationally recognized ear, nose and throat surgeon, Dr. Citardi is chief of otorhinolaryngology at Memorial Hermann-Texas Medical Center and professor and chair of the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School. He received his medical degree from the Johns Hopkins University School of Medicine, followed by residency training at Yale University and a rhinology fellowship at the Georgia Rhinology and Sinus Center. Dr. Citardi, who has been named to the list since 2005, specializes in the treatment of complicated sinus and nasal disease and is a core member of the Texas Sinus Institute and Texas Skull Base Physicians. His specialty interests include difficult-to-treat chronic sinusitis, revision sinus surgery and minimally invasive surgery for tumors of the nose and sinuses.

Samer Fakhri, MD

Dr. Fakhri, also a core member of the Texas Sinus Institute and Texas Skull Base Physicians, is professor, vice chair and residency program director in the department of Otorhinolaryngology. An internationally recognized rhinologist, Dr. Fakhri received his medical degree at McGill University in Montreal, Quebec, Canada. He completed residency training at McGill University Health Center and pursued fellowship training in rhinology at the Cleveland Clinic Foundation. He also completed a research fellowship in allergy and immunology at the Meakins-Christie Laboratories of McGill University. Dr. Fakhri’s areas of clinical interest include medical and surgical management of refractory chronic rhinosinusitis and sinonasal polyposis, endoscopic removal of benign and malignant sinus and nasal tumors, image-guided surgery, endoscopic lacrimal and orbital surgery, CSF leak repair and minimally invasive skull base surgery.

Soham Roy, MD

Dr. Roy is a recognized expert in operating room safety issues and a consultant in the development of innovative and safer surgical devices. An associate professor in the department, he serves as director of pediatric otolaryngology and quality officer. He received his undergraduate degree with highest distinction from Stanford University, received a full scholarship for medical education at Washington University School of Medicine in St. Louis, and completed his residency in otolaryngology at the University of Miami. He completed a fellowship in pediatric otolaryngology at the Children’s Hospital in Pittsburgh prior to joining the faculty at the University of Miami, where he was named Professor of the Year in 2003, an honor he received again at UTHealth Medical School in 2013. An internationally recognized speaker and author, Dr. Roy has received multiple awards for teaching, clinical care and original scientific research. His clinical interests are airway disorders in children, neonatal airway surgery, hearing loss, tonsil and adenoid disorders and neck masses in children.

Best Doctors was founded in 1989 by two physicians affiliated with Harvard Medical School, whose goal was to provide greater access to dependable, high-quality medical information and care of individuals with serious illness and injuries.

In addition, Drs. Citardi and Fakhri were named to the Castle Connolly Top Doctors list. Each year Castle Connolly Medical Ltd. Identifies top doctors based on an extensive nomination process open to all licensed physicians in America. Nominated physicians are reviewed and screened by a physician-led research team that selects the most outstanding as top doctors.

]]>https://med.uth.edu/orl/newsletter/three-orl-faculty-members-named-to-top-doctor-lists/feed/0Sialendoscopy: An Innovative Minimally Invasive Approach to the Treatment of Sialolithiasishttps://med.uth.edu/orl/newsletter/sialendoscopy-an-innovative-minimally-invasive-approach-to-the-treatment-of-sialolithiasis/
https://med.uth.edu/orl/newsletter/sialendoscopy-an-innovative-minimally-invasive-approach-to-the-treatment-of-sialolithiasis/#commentsSun, 23 Nov 2014 16:37:28 +0000https://med.uth.edu/orl/?p=6074Read the full article...]]>When Vida Smith Compton first saw otorhinolaryngologist Sancak Yuksel, M.D., in late summer 2013, she had pain and swelling beneath the ventral surface of her tongue on the right side, and in her neck under the mandible.

“I looked like I had the mumps under my right jaw, and I could hardly swallow,” says the 67-year-old Wharton, Texas, resident, who has a history of blocked salivary gland ducts going back to her teenage years. “Years ago, my ENT showed me how to manipulate the glands to release trapped saliva. But this time I was sore from my right ear all the way down to the middle of my chin, and it was too painful to touch.”
A CT scan revealed three large sialoliths – calcified masses also known as salivary stones – in the submandibular gland, the most common location. Sialoliths are found less commonly in the parotid gland, and rarely in the sublingual gland or minor salivary glands.

“We suspect sialolithiasis if swelling occurs when salivary flow is stimulated by the sight, smell or taste of food,” says Dr. Yuksel, an assistant professor in the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School. “If we’re lucky, we can see the swollen gland or locate the stones by palpating around the orifice of the gland duct or in the floor of the mouth. Otherwise, we rely on a CT scan to reveal density in the gland.”

The traditional method of treating sialolithiasis unresponsive to conservative management has been surgical excision of either the stone or the involved gland. Compton, however, was the beneficiary of a relatively new procedure called sialendoscopy. Used both diagnostically and therapeutically, sialendoscopy is a technically challenging procedure that allows endoscopic visualization of the gland and nonsurgical removal of stones small enough to fit through the duct, usually 5 millimeters or less in diameter.

Dr. Yuksel took Compton to the OR in October 2013. Using a very fine 1.1-millimeter endoscope equipped with a wire basket, he visualized the three stones, which ranged in size from 8 to 12 millimeters in diameter. “The stones were situated back to back like train cars and were so large that they were beyond the grasp of the basket,” he says. “I was able to maneuver the endoscope behind the farthest stone and use the basket to pull all three stones to the orifice of the duct.”

After making a tiny nick in the orifice, Dr. Yuksel removed all three sialoliths successfully. He re-scoped to check for smaller stones, cleaned the entire duct system of debris and sutured a tiny piece of plastic tubing in place as a stent to hold the orifice open. “The beauty of sialendoscopy is being able to provide patients relief with no external scar, no nerve damage and a lower risk of surgery-related complications,” he says.
Compton, who healed quickly, believes her salivary stones may have been caused by dehydration. Other causes may include abnormalities in calcium metabolism, reduced salivary flow rate, altered acidity of saliva caused by oropharyngeal infections and receiving radioactive iodine.

“I think Dr. Yuksel was shocked when he saw how big my stones were,” says Compton, who says that bad situations bring out her sense of humor. “Personally, I think he’s a really, really good doctor and a very thorough surgeon. I feel truly blessed to have been referred to him for a problem that came up in a matter of days. After the surgery, I told him I wanted the stones back so I could make a necklace. They’re mine, after all. I made them.”

]]>https://med.uth.edu/orl/newsletter/sialendoscopy-an-innovative-minimally-invasive-approach-to-the-treatment-of-sialolithiasis/feed/0Physicians’ Mission Satisfiedhttps://med.uth.edu/orl/newsletter/physicians-mission-satisfied/
https://med.uth.edu/orl/newsletter/physicians-mission-satisfied/#commentsSun, 23 Nov 2014 16:21:03 +0000https://med.uth.edu/orl/?p=6066Read the full article...]]>Jim Finley, who has been in the newspaper business for more than 30 years, writes a humor column for the Baytown Sun, a community newspaper published five days a week in Baytown, Texas, 25 miles east of Houston. In September 2013, he wrote a column entitled “Why So Blue with the Good News?” describing the emotions he felt after being discharged as a cancer patient following three years of treatment.
“Why was the sound of ‘You’re outta here’ so bittersweet?” he asked in his column. “Why aren’t I happy? It’s a syndrome called Physicians’ Mission Satisfied (PMS). Or put another way, I love these two guys and shall miss having them in my life, if not chiseling into my head.”

The “two guys” he’s referring to are otorhinolaryngologist Ron J. Karni, M.D., and facial plastic and reconstructive surgeon Tang Ho, M.D., both of whom are affiliated with Memorial Hermann-Texas Medical Center and assistant professors in the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School. Finley met them in late July 2010, when his grandson-in-law Christian Erikson, M.D., a pediatric critical care specialist at the academic medical center, and his granddaughter Katie Erikson, a former nurse at Memorial Hermann, encouraged him to see a specialist.“It all started after I had cataract surgery in October 2009,” says Finley, former managing editor of the Baytown Sun who goes by the nickname T. “I got new glasses, and they were rubbing against a spot on my head above my right ear. I went back to have them adjusted, which eventually led to my discovery that the little bump on my head was actually a very large squamous cell carcinoma invading the bone of my ear. Dr. Karni called me at home a few days after the biopsy. ‘T, we’ll do surgery on Sept. 1,’ he said. I thought, ‘What a way to start the football season!’”

Dr. Karni describes the tumor as a very aggressive and invasive malignancy of the neck. “When we examined T, we knew his temporal bone would have to be removed,” he says. “Dr. Yuksel was able to remove a considerable portion of the bone in what turned out to be a very long operation involving resection of the tumor and a major reconstruction.” Sancak Yuksel, M.D., is an assistant professor in the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School.

“We worked together as a team,” Dr. Karni says. “Dr. Yuksel is a world-class temporal bone surgeon. I managed the oncological aspect from the top of the neck to the bottom of the ear. Dr. Ho prepared an anterolateral thigh (ALT) free-tissue transfer while we were working on the ear. I’m fortunate to have such great guys around me whose surgical skills complement each other so well. It allows us to do amazing work for our patients.”

The size of the tumor necessitated sacrifice of a portion of Finley’s ear and the facial nerve on the right side, which allows for facial movement. “We used the ALT free-tissue transfer to reconstruct the facial defect that resulted from the tumor removal,” Dr. Ho says. “We transplanted T’s thigh tissue with blood vessels attached, and reconnected the vessels in the neck to reconstruct the large defect on his face. We know that these tissues will shrink a great deal over time, so we make the transfer larger initially to compensate for anticipated loss in volume.”

In an earlier humor column entitled “Beating the Grapefruit Tumor,” written in September 2010 a few days after his discharge from the hospital, Finley offered his own description of the surgery. “What Dr. Karni taketh away, Dr. Ho restoreth,” he wrote. “A quiet, studious man, Dr. Ho – if you can believe this – took part of my right thigh and threw it up there to cover the hole left by the removal of the ‘grapefruit.’ I now look like I have this little beehive there, and I’m glad I won’t be running the hurdles anytime soon. This is a shame, but for the time being at least, I no longer look like Brad Pitt.”

A year later, in October 2011, Dr. Ho took Finley back to the OR to perform a comprehensive facial reanimation. “At the time of tumor resection, using a nerve graft from T’s thigh, we reconstituted the continuity of the facial nerve to restore facial tone,” he says. “Later, to further improve facial symmetry and restore his ability to smile, we did a temporalis tendon transfer, rerouting the temporalis muscle from the side of his jaw to the corner of his mouth. To address his inability to close his right eye as a result of the original facial nerve resection, we used a platinum chain implant in the upper eyelid. To correct the problem of ectropion and excess tearing, we performed a procedure that tightened his lower eyelid.

“We eat, we talk, we blink our eyes – all without even thinking about it,” Dr. Ho says. “When you lose the ability to close your eye, to smile and to talk without slurring, it totally changes how people react to you, which in turn dramatically changes your life. The ultimate goal of what we do with facial reanimation is to help patients reintegrate into their family and social lives.”

Over those three years of treatment Finley, his wife Margie, Dr. Karni and Dr. Ho established a personal relationship. In “Why So Blue with the Good News?” he wrote, “There were many Karni-Ho office visits. Too many to count. Since I slept through most of the surgeries, their office is where I really got to know and admire them. They became like family. So much so that you could almost visualize them sitting at the table with us on, say, Thanksgiving.”

“‘This is great turkey,’ I could imagine Dr. Karni saying. ‘May I have some more, Margie?’”

“No wonder Wife Margie got emotional when I was booted out of their office. With tears in her eyes, she gave both a hug and told them how much she appreciated them and cared for them.”

“When we finally discharged T, it was a happy time and truly an emotional moment for everyone involved,” Dr. Ho says. “Both Dr. Karni and I have gotten to know him and his family very well, and he’s become a part of our lives. The day we discharged him from the clinic, we all had a group hug. It was a bittersweet moment.”

As a subspecialist in oncological head and neck surgery, Dr. Karni follows his cancer patients for five years and often longer. “Surgery is the smallest thing I do in the life of a cancer patient,” he says. “I give them the diagnosis, then I stay with them and monitor them for years to come, through office visits, follow-up scans and evaluation of the results. We spend hours together. The first few times they come to the office, it’s about treatment. The last 20 or so times you get to know them personally. T is such an interesting person. He always comes over and gives me a hug and asks me how my family is doing. When I leave the exam room, I feel like I should thank him. A success story like his gives us tremendous pleasure as physicians. It’s a deeply personal relationship, and I always walk out of the room feeling better.

“It’s rewarding and heartwarming to see someone who has faced the specter of death, gone through a massive surgery and risen above it,” Dr. Karni says. “T reminds me of why we’re in medicine. He’s not just a survivor. He’s a superhero.”